Individual
MS. DONNA MARIE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW MASSACHUSETTS
Contact information
Practice address
17 ROBERT ST, LEE, MA 01238
(413) 243-0580
Mailing address
PO BOX 167, LEE, MA 01238-0167
(413) 243-0580
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
113494
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113494
LICSW
MA
Enumeration date
09/07/2007
Last updated
09/07/2007
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